Laparoscopic Access with Optical Gasless Trocar: A Single-center Experience of 7431 Procedures

To analyze the complications experienced and describe laparoscopic surgery using a gasless optical trocar. A retrospective study. A department of obstetrics and gynecology in a tertiary center in Italy. Seven thousand four hundred thirty-one surgical procedures were performed. From the hospital database, data were evaluated regarding major complications of laparoscopy with the ENDOPATH XCEL Bladeless Trocar (Ethicon, Johnson & Johnson, Somerville, NJ) performed between 2000 and 2017 by different laparoscopic surgeons. The mean age of the patients was 40.66 ± 12.06 years (range, 13–91 years). The mean body mass index was 22.12 ± 3.64 kg/m2 (range, 15.74–41.51 kg/m2). The overall complication rate was 0.31% (23/7431 cases). Major complications included stomach perforation in 1 procedure (0.014%), ileal perforation in 2 procedures (0.028%), and blood vessel perforation in 1 procedure (0.014%). Twelve procedures were completed with initial access through the omentum and 2 through an ovarian cyst. In 5 procedures (0.067%), conversion to laparotomy was required because the optical trocar failed to reach the abdominal cavity. With regard to complications requiring further intervention (n = 9), the rate of complications was 0.12%. The optical gasless trocar is a feasible laparoscopic entry technique. The complication rate is lower than those reported previously.